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P/N 5215 Hertel Exophthalmometer Instructions 1. 2. Purpose: Hertel Mirror Exophthalmometers are used to measure the eye’s exact protrusion out of the orbit (degree of proptosis) to determine its position along the sagittal. This examination is of particular interest in retrobulbar, space-occupying conditions such as inflammation, hemorrhaging and tumors. The distance between the lateral orbital rim and the corneal apex serves as the dimension of the measurement. Under normal conditions, the distance between the apex of the cornea and the orbital wall is approximately 18mm. This value should only be regarded as a statistical average, from which there may well be upward or downward deviations. Depending upon the configuration of the osseous orbit, a value of 15mm might be pathological whereas 21mm might be normal. Continuous checks are therefore more useful than individual measurements. Physiologically, there are also certain differences in the degree of proptosis in each eye. Approach: The examiner sits opposite the patient at eye level. The exophthalmometer is then positioned with the index points (1.) at the temporal lateral orbital walls. The instrument is maneuvered using both hands and firmly propped first against the patient’s right orbital wall on the temporal side (which should be felt against the lowest part of the support point). The moveable part on the right side is then set in such as way that the patient’s left orbital wall lies against the lowest part of the arched support. The distance between the lateral orbits (on scale 2) should be noted for future correlation. The examiner asks the patient to look straight ahead with eyelids wide open. The examiner measures for proptosis in each eye seperately by looking into the mirror (which has a millimeter scale marked on it) with one eye and moving the head side to side until the red fixations lines match up, thus eliminating any paralax. The examiner can now determine the position of the corneal apex of the patient from the millimeter reading. Record this distance for each eye based on the mm scale. Richmond Products Inc 4400 Silver Ave SE Albuquerque, NM 87108 Tel: 505-275-2406 FAX: 810-885-8319 E-mail: [email protected] P/N 910956 Skull Orbital Rim Corneal protrusion Distance Measure